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<head>
    <meta charset="UTF-8">
    <title>《第二类医疗器械经营备案凭证》补证</title>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1, user-scalable=no">
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    <link rel="stylesheet" href="#(basePath)/static/web/index/css/index.css">
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<body>
<div class="page">
    <div class="page__hd">
        <header class="weui-header">
            <h1 class="weui-header-title" style="font-size: 24px;">《第二类医疗器械经营备案凭证》<br/>补证</h1>
        </header>
    </div>
    <div class="page__bd page__bd_spacing">
        <form action="#(basePath)/wfw/spyxmp/delylqxjybapz/save" method="post" data-role="form">
            <input type="hidden" name="type" value="1">
            <div class="weui-cells weui-cells_form weui-cells_radio weui-cells_radio_native">
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">备案编号</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="babh" value="#(data.babh??)"
                               placeholder="请输入备案编号" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">企业名称</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="qymc" value="#(data.qymc??)"
                               placeholder="请输入企业名称" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">备案日期</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="date" name="barq" value="#(data.barq??)"
                               placeholder="请选择备案日期" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">组织机构代码</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="tyshxydm" value="#(data.tyshxydm??)"
                               placeholder="请输入组织机构代码" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">法定代表人</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="fddbr" value="#(data.fddbr??)"
                               placeholder="请输入法定代表人" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">企业负责人</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="qyfzr" value="#(data.qyfzr??)"
                               placeholder="请输入企业负责人" required>
                    </div>
                </div>
                <div class="weui-cell weui-cell__title">
                    经营方式？
                </div>
                <label class="weui-cell weui-check__label" for="jyfs1">
                    <div class="weui-cell__bd">
                        <input type="radio" class="weui-check" name="jyfs" value="1" id="jyfs1" required #(data.jyfs??=="1"?"checked":"")>
                        <span>批发</span>
                    </div>
                </label>
                <label class="weui-cell weui-check__label" for="jyfs2">
                    <div class="weui-cell__bd">
                        <input type="radio" class="weui-check" name="jyfs" value="2" id="jyfs2" required #(data.jyfs??=="2"?"checked":"")>
                        <span>零售</span>
                    </div>
                </label>
                <label class="weui-cell weui-check__label" for="jyfs3">
                    <div class="weui-cell__bd">
                        <input type="radio" class="weui-check" name="jyfs" value="3" id="jyfs3" required #(data.jyfs??=="3"?"checked":"")>
                        <span>批零兼售</span>
                    </div>
                </label>
                <div class="weui-cell weui-cell__title">
                    经营模式？
                </div>
                <label class="weui-cell weui-check__label" for="jyms1">
                    <div class="weui-cell__bd">
                        <input type="radio" class="weui-check" name="jyms" value="1" id="jyms1" required #(data.jyms??=="1"?"checked":"")>
                        <span>销售医疗器械</span>
                    </div>
                </label>
                <label class="weui-cell weui-check__label" for="jyms2">
                    <div class="weui-cell__bd">
                        <input type="radio" class="weui-check" name="jyms" value="2" id="jyms2" required #(data.jyms??=="2"?"checked":"")>
                        <span>为其他生产经营企业提供贮存、配送服务</span>
                    </div>
                </label>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">住所</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="zs" value="#(data.zs??)"
                               placeholder="请输入住所地址" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">经营场所</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="jycs" value="#(data.jycs??)"
                               placeholder="请输入经营场所地址" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">库房地址</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="kfdz" value="#(data.kfdz??)"
                               placeholder="请输入库房地址" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">经营范围</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="jyfw" value="#(data.jyfw??)"
                               placeholder="请输入经营范围" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">联系人名称</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="lxrxm" value="#(data.lxrxm??==null?session.wxUserInfo.name:data.lxrxm??)"
                               placeholder="请输入联系人名称" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">身份证号</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="lxrzjhm" value="#(data.qyfzr??)"
                               placeholder="请输入联系人身份证号" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">电话</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="lxrdh" value="#(data.lxrdh??==null?session.wxUserInfo.phone:data.lxrdh??)"
                               placeholder="请输入联系人电话" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">传真</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="text" name="lxrcz" value="#(data.lxrcz??)"
                               placeholder="请输入联系人传真" required>
                    </div>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__hd"><label class="weui-label">电子邮件</label></div>
                    <div class="weui-cell__bd">
                        <input class="weui-input" type="email" name="lxryx" value="#(data.lxryx??)"
                               placeholder="请输入联系人电子邮件" required>
                    </div>
                </div>

                <div class="weui-cell">
                    <label class="cuiui-label ">遗失、损毁原因原因</label>
                </div>
                <div class="weui-cell">
                    <div class="weui-cell__bd weui-cell__primary">
                          <textarea class="weui-textarea" placeholder="请输入遗失、损毁原因" rows="3"
                                    name="reason">#(data.reason??)</textarea>
                    </div>
                </div>
                <div data-role="upload"
                     data-content='{"label": "遗失声明（<label style=color:red>或情况说明，需盖章</label>）", "params": {"tableName": "SPYXMP_DELYLQXJYBAPZ", "sblsh": "#(data.APPLYID??)"}}'></div>

            </div>
            <div class="weui-btn-area">
                #if(model??=="readonly")
                <a href="#(basePath)/wfw/spyxmp/applyItem/toSbls" class="weui-btn weui-btn_primary">返回申报历史</a>
                #else
                <button class="weui-btn weui-btn_primary" type="submit">提交申请</button>
                #end
            </div>
            <br><br>
        </form>
    </div>
    <div class="page__footer">

        #include("/WEB-INF/main/footer-spyxmp.html")
    </div>
</div>
<script src="#(basePath)/static/js/weuiUpload.js"></script>
<script>
    $("#jyfs").select({
        title: "选择经营方式",
        items: [
            {
                title: "批发",
                value: "1",
            },
            {
                title: "零售",
                value: "2",
            },
            {
                title: "批零兼",
                value: "3",
            }
        ]
    });
    $("#jyms").select({
        title: "选择经营模式",
        items: [
            {
                title: "销售医疗器械",
                value: "1",
            },
            {
                title: "为其他生产经营企业提供贮存、配送服务",
                value: "2",
            }
        ]
    });
</script>
</body>
</html>